Individual
MACIANNE THOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2655 S LAKE ERIE DR, WEST VALLEY CITY, UT 84120-7350
(385) 441-4900
Mailing address
2655 S LAKE ERIE DR, WEST VALLEY CITY, UT 84120-7350
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/05/2023
Last updated
09/05/2023
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